What is AERD/Samter’s Triad?
Aspirin Exacerbated Respiratory Disease (AERD), also known as Samter’s Triad or Aspirin Sensitive Asthma, is a chronic medical condition that consists of asthma, recurrent sinus disease with nasal polyps, and a sensitivity to aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs). Approximately 10% of all adults with asthma and 40% of patients with asthma and nasal polyps are sensitive to aspirin and NSAIDs.
What are the symptoms?
Patients with AERD/Samter’s Triad usually have asthma, nasal congestion, and nasal polyps, and often do not respond to conventional treatments. Many have experienced chronic sinus infections and can lose their sense of smell. The characteristic feature of AERD/Samter’s Triad is that patients develop reactions triggered by aspirin or other NSAIDs.
These reactions can include:
- Increased nasal congestion or stuffiness
- Eye watering or redness
- Cough, wheezing, or chest tightness
- Frontal headache or sensation of sinus pain
- Flushing and/or a rash
- Nausea and/or abdominal cramping
- General feeling of malaise, sometimes accompanied by dizziness
If you not do have asthma, nasal congestion and/or nasal polyps but experience reactions to aspirin or NSAIDs, click here and here to learn about the Brigham and Women’s Aspirin and NSAID Allergy Clinic. The Aspirin/NSAID Allergy new patient packet can be found here.
Chronic rhinosinusitis with nasal polyps (CRSwNP) is a complicated disease with no definitive cure. As with other complex diseases, experts largely agree that a multidisciplinary approach is the most beneficial for patients. We recommend that patients with CRSwNP seek care from both an allergist/immunologist and otolaryngologist. The allergist/immunologist can diagnose and manage the disease and other co-morbid conditions while the otolaryngologist can perform nasal endoscopies, biopsies and surgery if needed. In the case of aspirin-exacerbated respiratory disease (AERD), aspirin desensitization is often recommended after surgery to increase success and prevent the polyps from recurring. Collaboration between allergists/immunologists and otolaryngologists gives a well-rounded, patient-centered approach to effectively manage CRSwNP. More information about the benefits of a multidisciplinary approach can be found here.
In November 2019, the NIH hosted the first-ever conference dedicated to chronic rhinosinusitis with nasal polyps (CRSwNP). Clinical experts from allergy and otolaryngology, along with scientific researchers met to discuss current treatments for the disease and directions for future research. Historically, CRSwNP has been treated with a combination of intranasal and corticosteroids and endoscopic sinus surgery. Recently, dupilumab, a biologic that blocks IL-4 and IL-13 signaling, was FDA approved as a highly effective treatment for CRSwNP. As dupilumab is gaining popularity as a treatment option, other biologics are currently being researched and developed. The emergence of biologics as treatments for CRSwNP introduces new questions including the role of endoscopic surgery paired with biologic treatment and the cost-effectiveness of each (apart and together).
There are several opportunities for research on this topic. One ideal clinical trial would compare biologics versus surgery treatment on quality of life outcome. However, such a trial is difficult to ethically and logistically design. There is hope that use of the FDA’s adaptive clinical trial design will be advantageous in overcoming those hurtles. Another research opportunity lies in investigating whether response to traditional corticosteroids can be used to predict responsiveness to biologics. There are many more questions to be answered as biologics gain popularity as treatment options. This report highlights several considerations concerning biologic treatment moving forward.
In this paper, Drs. Cho, Hamilos, Han, and Laidlaw review the diagnoses and treatments for different types of chronic rhinosinusitis (CRS) . The two most commonly described phenotypes of CRS are CRS with nasal polyps (CRSwNP) and CRS without nasal polyps (CRSsNP). There is actually a third main phenotype called allergic fungal rhinosinusitis which is characterized by inflammation in response to fungus in nasal mucus. Aside from the three main phenotypes, there are also sub-phenotypes such as cystic fibrosis and aspirin-exacerbated respiratory disease (AERD). Each type of CRS requires different treatments. The nasal polyps in patients with AERD are eosinophilic and are often recurrent and difficult to manage. Treatments for CRS range from intranasal corticosteroids, saline irrigations, antibiotics, endoscopic sinus surgery and more recently, biologics. The specifics on each phenotype and their corresponding treatment methods can be found here.